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Topic: Insurance & Imitrex (Read 492 times) |
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emilysmommy
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Insurance & Imitrex
« on: Oct 14th, 2002, 9:07pm » |
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How do you get the insurance company to cover you for the amount of meds needed? I have Cigna & they suck. I have been crying all day on the phone with them and the doctors office. They refuse to cover anymore than 6 boxes a month & only that because I pushed and pushed. Injectables are an exclusion under my plan. I'm having at least one cluster a day, somtimes more. This will never last me all month! My doctor called in 9 boxes, but they will not cover it! Their reasoning is the user may become dependent! HA HA HA! Why is it that they have no problem paying for a 30 day supply of vicodin or other highly addictive narcotics, which is habit forming, but when it comes to the expensive stuff--forget it! I have a neuro appt. on Monday & plan on talking to him about getting oxygen but I dread the fight with the insurance company! Do any of you get the amount of meds you need? If so, how?
Thanks
Michelle
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Mark C
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Onward through the fog.
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Re: Insurance & Imitrex
« Reply #1 on: Oct 15th, 2002, 12:14pm » |
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Hi Michelle,
I have been going through the same thing and I have a couple of suggestions that have helped stock my "arsenal".
First, samples, the doctors get lots of samples from the drug companies and give them away, ask for them. I have a Neuro and a General and get samples from both.
Second, have your doctors write letters of 'Medical Necessity" stating the need you have for these medicines. It amazing how well this works. Remember, the squeaky wheel gets the grease.
Third, see if your HMO has a "patient advocacy" program to help you fight for your rights. See if your employerers HR department has any pull, it cant hurt, make some noise!
Fourth, My HMO has a mail order pharmarcy that allows me a much greater quantity at a lower price than a walk in pharmacy, check it out.
Finally, if off periods, STOCK UP, most of us are ECH and between the sample method and the mail in method I can get a pretty good supply of stuff when the beast returns, and he always returns.
Good luck!
Mark 
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emilysmommy
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Posts: 35
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Re: Insurance & Imitrex
« Reply #2 on: Oct 15th, 2002, 4:28pm » |
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Hi Mark. Thanks for you response.
I'm literally at the end of my rope with the Insurance Comp. My doctor has called in several times and told them this drug is medically necessary but they don't listen. She told them that this was the only thing that worked to relieve the pain, but do they care? They will give a bunch of BS reasons until we just give up. In a email today they state that I'm on several meds. for this condition. How would they know what the meds are for? The only thing else that I have a prescription for is Elavil and it doesn't work! I also got some vicodin from the ER, but that was a one time thing. I'm seeing a neuro Monday so hopefully he can convince them that I need this stuff. I've been dancing around trying not to inject unless I think I'm gonna die from the pain. They say they "can" approve more, but apparently they don't feel the reasons my dr. has given are good enough. They also think CH's are an occasional thing. HA HA
Today the insurance company told us this:
The additional challenge with this patient is they are receiving more
> than just this medication to treat the same symptoms. Our policy is
> structured to make sure that they have the necessary drugs (certainly)
> to treat the condition. The issue exists that the medication profile
> indicates the member is taking multiple medications from different
> classes on a chronic basis (continuous) versus the acute basis
> (periodic) that is more common with this condition.
> FDA labelling of the drug indicates the following:
>
> IMITREX Injection is indicated for 1) the acute treatment of migraine
> attacks with or without aura and 2) the acute treatment of cluster
> headache episodes.
>
> And
>
> IMITREX Injection should only be used where a clear diagnosis of
> migraine or cluster headache has been established. The prescriber
> should be aware that cluster headache patients often possess one or
> more predictive risk factors for coronary artery disease (CAD).
>
> So, to answer your questions:
> 1. We can approve greater quantities, but a physician should validate
> that they have eliminated any other contributing factors (ie. CAD as
> noted
> above) and that the patient is being treated for the genuine
> underlying condition and not just the symptoms.
> 2. A specialist could be a pain management specialist, a neurologist,
> or perhaps even a cardiologist to verify that other conditions are not
> the cause of the headaches. .
>
> The patient should note that these medications will only treat the
> symptoms (ie. the headache), but it would be better (if possible) to
> treat the underlying cause of the symptoms: treat the >cause & you won't have the headache anymore!
This last sentence makes me want to vomit.
Michelle
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domm
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Re: Insurance & Imitrex
« Reply #3 on: Oct 15th, 2002, 5:30pm » |
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anvilhead posted this in the general board.:
Hi folks,
I searched for this on the board to see if it was redundant and I couldn't find anything like it.
It seems Glaxo provides assistance in paying for some of their drugs, particularly Imitrex, to those without insurance.
Here is the link I found.
http://headaches.about.com/bl-rxassist-fh.htm
I hope this helps you. Obviously you need to have a prescription first.
Good luck.
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emilysmommy
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Re: Insurance & Imitrex
« Reply #4 on: Oct 15th, 2002, 6:53pm » |
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Hi Domm. Thanks for the link. Unfortunatley, I think I would be excluded from any assistance since we do have health insurance. It's just the insurance is giving us such a hard time at covering the meds.
Michelle
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domm
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http://www.clusterheadachesRe: Insurance & Imitrex
« Reply #5 on: Oct 15th, 2002, 7:57pm » |
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Michelle - here's some other places from the OUCH board that may provide some assistance. Good luck
domm
(I couldn't get it to copy over so here's how you get there)
click on the OUCH website (button to the left), then click on cluster help, then cluster resources, then dealing with insurance
hope this helps
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CHERRILL
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Re: Insurance & Imitrex
« Reply #6 on: Oct 18th, 2002, 11:57am » |
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MICHELLE,
I TOO HAVE CIGNA INS. AND HAVE BEEN GOING THROUGH THE SAME THING. I ALSO SPENT THE WHOLE DAY MON. ON THE PHONE CRYING TO THE DOCTOR AND THE INS. CO. MY DOC TRIED TO GET THEM TO APPROVE 12 BUT THEY WILL ONLY PAY FOR 4 A MONTH. ONCE AGAIN I CALLED THE INS. CO. TODAY BECAUSE THEY TURNED DOWN HER WRITTEN REQUEST. THEY TOLD ME TO HAVE HER CALL THEM A SPEAK TO SOMEONE IN PERSON. IF YOU HAVEN'T DONE THIS HAVE YOUR DOC CALL FOR MEDICAL NECCESITY 1-800-832-3211, OPTION 2, OPTION 3, OPTION 2. ALSO I CALLED GLAXO SMITH KLINE TODAY AND GAVE THEM ALL THE INFORMATION. THEIR ASSIGNING A CASE WORKER TO WORK WITH MY DOC. TO HELP FIGHT THE INS. CO. IF ALL ELSE FAILS. JUST CALL AROUND AND TRY AND FIND THE CHEAPEST PHARMACY. THE CHEAPEST I FOUND WAS 99.00 FOR 1 REFILL WHICH IS TWO INJ. GOOD LUCK AND I ALSO HAVE BEEN SUFFERING WITH 3 TO 4 HA A NIGHT FOR THE PAST TWO WEEKS. IF YOU FIND OUT ANY OTHER INFO. ON HOW TO GET THEM TO PAY PLEASE LET ME KNOW.
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Drk^Angel
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Cherrill... If ya don't mind, could ya tone it down with the caps... It looks like you're screamin' at everyone. Thanks.
PFDAN................................. Drk^Angel
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emilysmommy
New Board Newbie
Posts: 35
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Re: Insurance & Imitrex
« Reply #8 on: Oct 18th, 2002, 7:12pm » |
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Hi Cherril. I'm seeing a neuro on Monday & I hope he can help talk to the Ins. comp. I just recv'd a letter from them today stating they "can" make exeptions, but apparently someone suffering twice a day from a ch isn't good enough from them. My GP is a freakin moron anyways. She's no help. I'm gonna tell her I'll start snorting the Imitrex pills if she doesn't help me soon. I guess I should just find a new GP. I'm gonna keep on the Insurance too. Good luck to you too.
Michelle
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